Provider Demographics
NPI:1245261833
Name:TRI-STATE OPHTHALMOLOGY ASSOCIATES PSC
Entity type:Organization
Organization Name:TRI-STATE OPHTHALMOLOGY ASSOCIATES PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-324-2451
Mailing Address - Street 1:2841 LEXINGTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101
Mailing Address - Country:US
Mailing Address - Phone:606-324-2451
Mailing Address - Fax:606-324-7123
Practice Address - Street 1:2841 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-3009
Practice Address - Country:US
Practice Address - Phone:606-324-2451
Practice Address - Fax:606-324-7123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2115848Medicaid
KY65931172Medicaid
KYCA4418OtherMEDICARE RAILROAD
KYCA4418OtherMEDICARE RAILROAD